Characterization of class 1 integrons in metallo-β-lactamase-producing Acinetobacter baumannii isolates from hospital environment

BACKGROUND AND OBJECTIVE

The emergence and widespread dissemination of antibiotic resistance in A. baumannii, has become a globally challenge. The increasing hospital outbreaks by multi-drug resistant (MDR) A. baumannii strains, shows the necessity of continuous monitoring to find sources of resistant strains in hospitals. This study aimed to identify the presence of class 1 integrons and metallo-β-lactamase (MBL) related genes in A. baumannii isolates from hospital environment.

METHODS

In order to identify A. baumannii isolates, a total of 297 environmental samples were collected from burn wards and intensive care units (ICUs) of two university hospitals. Resistance to common antibiotics was studied by disk diffusion method and microbroth dilution assay was used to determine the minimum inhibitory concentrations (MICs) of imipenem, colistin and tigecycline. The A. baumannii isolates were studied by polymerase chain reaction (PCR) for the presence of class 1 integrons (intI1, intl CS) and metallo-β-lactamases (MBLs) (blaIMP, blaVIM, blaNDM) genes.

RESULTS

A. baumannii was identified in 68/297 (22.9%) of hospital environment. All A. baumannii strains were multidrug-resistant (MDR), but none of them were resistant to colistin, tigecycline and ampicillin-sulbactam. All (100%) and 38 (95.0%) of A. baumannii isolates from ICUs and burn wards were imipenem resistant respectively. Class 1 integrons was identified in 30/40 (75.0%) and 23/28 (82.1%) isolates from burn wards and ICUs respectively. Two different types of gene cassettes were identified, which included: arr-2, ereC, aadA1, cmlA5 and arr2, cmlA5. MBL genes including blaVIM and blaIMP were detected in 26/28 (92.8%), 27/28(96.4%) and 39/40 (97.5%) and 31/40 (77.5%) of the isolates from the ICUs and the burn wards respectively. None of the isolates contained the blaNDM-1 gene.

CONCLUSION

The findings of the present study showed that the isolation rate of MBL producing carbapenem-resistant A. baumannii (CRAB) was relatively high in the environmental surface of burn wards and ICUs, which can be considered as a potential source of outbreaks in hospitalized patients.

A review on factors related to patient comfort experience in hospitals

The creation of a welcoming hospital atmosphere is necessary to improve patient wellbeing and encourage healing. The goal of this study was to examine the variables affecting hospitalised patients' comfort. The study procedure included a thorough search of the Web of Science and Scopus databases, as well as the use of software analytic tools to graphically map enormous literature data, providing a deeper understanding of the linkages within the literature and its changing patterns. Insights from a range of disciplines, including engineering, psychology, immunology, microbiology, and environmental science, were included into our study using content analysis and clustering approaches. The physical environment and the social environment are two crucial factors that are related to patient comfort. The study stress the need of giving patient comfort a top priority as they heal, especially by tackling indoor air pollution. Our research also emphasises how important hospital care and food guidelines are for improving patient comfort. Prioritising patients who need specialised care and attention, especially those who have suffered trauma, should be the focus of future study. Future research in important fields including trauma, communication, hospital architecture, and nursing will be built on the findings of this study. To enhance research in these crucial areas, worldwide collaboration between experts from other nations is also advised. Although many studies stress the significance of patient comfort, few have drawn conclusions from a variety of disciplines, including medicine, engineering, immunology, microbiology, and environmental science, the most crucial issue of thoroughly researching the improvement of patient comfort has not been addressed. Healthcare workers, engineers, and other professions will benefit greatly from this study's investigation of the connection between hospital indoor environments and patient comfort.

Environmental contamination across multiple hospital departments with multidrug-resistant bacteria pose an elevated risk of healthcare-associated infections in Kenyan hospitals

BACKGROUND

Healthcare-associated infections (HAIs) are often caused by multidrug-resistant (MDR) bacteria contaminating hospital environments which can cause outbreaks as well as sporadic transmission.

METHODS

This study systematically sampled and utilized standard bacteriological culture methods to determine the numbers and types of MDR Enterococcus faecalis/faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and Escherichia coli (ESKAPEE) from high-touch environments of five Kenyan hospitals; level 6 and 5 hospitals (A, B, and C), and level 4 hospitals (D and E), in 2018. Six hundred and seventeen high-touch surfaces across six hospital departments; surgical, general, maternity, newborn, outpatient and pediatric were sampled.

RESULTS

78/617 (12.6%) of the sampled high-touch surfaces were contaminated with MDR ESKAPEE; A. baumannii, 23/617 (3.7%), K. pneumoniae, 22/617 (3.6%), Enterobacter species, 19/617 (3.1%), methicillin resistant S. aureus (MRSA), 5/617 (0.8%), E. coli, 5/617 (0.8%), P. aeruginosa, 2/617 (0.3%), and E. faecalis and faecium, 2/617 (0.3%). Items found in patient areas, such as beddings, newborn incubators, baby cots, and sinks were the most frequently contaminated. Level 6 and 5 hospitals, B, 21/122 (17.2%), A, 21/122 (17.2%), and C, 18/136 (13.2%), were more frequently contaminated with MDR ESKAPEE than level 4 hospitals; D, 6/101 (5.9%), and E, 8/131 (6.1%). All the sampled hospital departments were contaminated with MDR ESKAPEE, with high levels observed in newborn, surgical and maternity. All the A. baumannii, Enterobacter species, and K. pneumoniae isolates were non-susceptible to piperacillin, ceftriaxone and cefepime. 22/23 (95.6%) of the A. baumannii isolates were non-susceptible to meropenem. In addition, 5 K. pneumoniae isolates were resistant to all the antibiotics tested except for colistin.

CONCLUSION

The presence of MDR ESKAPEE across all the hospitals demonstrated gaps in infection prevention practices (IPCs) that should be addressed. Non-susceptibility to last-line antibiotics such as meropenem threatens the ability to treat infections.

The impact of bedside wipes in multi-patient rooms: a prospective, crossover trial evaluating infections and survival

BACKGROUND

Multidrug-resistant organisms (MDROs) are prevalent on high-touch surfaces in multi-patient rooms.

AIM

To quantify the impact of hanging single-use cleaning/disinfecting wipes next to each bed. Pre-specified outcomes were: (1) hospital-acquired infections (HAIs), (2) cleaning frequency, (3) MDRO room contamination, (4) new MDRO acquisitions, and (5) mortality.

METHODS

Clustered randomized crossover trial at Shamir Medical Center, Israel (October 2016 to January 2018). Clusters were randomly assigned to use for cleaning either single-use quaternary ammonium wipes (Clinell) or standard practices (reusable cloths and buckets with bleach). Six-month intervention periods were implemented in alternating sequence, separated by a washout period. Five high-touch surfaces were monitored by fluorescent markers. Study outcomes were compared between periods using generalized estimating equations, Poisson regression, and Cox proportional hazards models.

FINDINGS

Overall, 7725 patients were included (47,670 person-days), 3793 patients in rooms with intervention cleaning and 3932 patients in rooms with standard practices. During the intervention, there was no significant difference in HAI rates (incidence rate ratio: 1.6; 95% confidence interval (CI): 0.7-3.5; P = 0.3). However, in intervention rooms, the frequency of environmental cleaning was higher (odds ratio: 3.73; 95% CI: 2.0-7.1; P < 0.0001), MDRO environmental contamination rate was insignificantly lower (odds ratio: 0.7; 95% CI: 0.5-1.0; P = 0.06), new MDRO acquisition rate was lower (hazard ratio: 0.4; 95% CI: 0.2-1.0; P = 0.04), and in-hospital mortality rate was lower (incidence rate ratio: 0.8; 95% CI: 0.7-1.0; P = 0.03).

CONCLUSION

Hanging single-use cleaning/disinfecting wipes next to each bed did not affect the HAI rates but did improve the frequency of cleaning, reduce MDRO environmental contamination, and was associated with reduced incidence of new MDRO acquisitions and reduced mortality. This is a feasible, recommended practice to improve patient outcomes in multi-patient rooms.

Genomic relatedness and dissemination of bla NDM-5 among Acinetobacter baumannii isolated from hospital environments and clinical specimens in Thailand

Background

Acinetobacter baumannii (A. baumannii) is an important cause of nosocomial infection, especially in intensive care units (ICUs). It has the propensity to tolerate various environments and multiple classes of antibiotics. Our study aimed to characterize the comparative genomes of A. baumannii from hospital environments and clinical isolates.

Methods

Clinical and environmental A. baumannii isolates were collected from a university hospital. Antibiotic susceptibility testing was performed, antibiotic resistance genes (ARGs) were characterized, and repetitive element palindromic-PCR (rep-PCR) typing was performed. Eight representative A. baumannii isolated from environmental and clinical samples from the same wards were selected for whole-genome sequencing (WGS) using the Illumina platform.

Results

A total of 106 A. baumannii isolates were obtained from 312 hospital environmental samples. A high percentage of samples with A. baumannii colonization were detected from AMBU bags (77.9%), followed by bedrails (66.7%) and suction tubes (66.7%). We found that 93.4% of the environmental isolates were multidrug-resistant A. baumannii (MDRAB), and 44.7% were extremely drug-resistant A. baumannii (XDRAB). bla _OXA-23 bla _NDM, and bla _OXA-58 were present in 80.2%, 78.3%, and 0.9% of all isolates, respectively. Sixty-one A. baumannii isolates were collected from patient specimens in the same ward. Among all A. baumannii clinical isolates, MDRAB and XDRAB accounted for 82% and 55.7%, respectively. The most dominant ARGs identified was bla _OXA-23 (80.3%), followed by bla _NDM (55.7%). The genetic diversity of all isolates using rep-PCR could be divided into 33 genotypes. The genome size of eight A. baumannii ranged from 3.78-4.01 Mb. We found six of eight strains to be bla _NDM-5-harboring A. baumannii. Mobile genetic elements (MGEs), such as integron1 (intl1), located upstream of bla _NDM-5 were observed. The phylogenomic relationship of the core and pan genomes as well as the single nucleotide polymorphism (SNP) count matrix revealed the genetic similarity of A. baumannii environmental and clinical strains obtained from the same ward.

Conclusion

This study confirmed that A. baumannii colonized in hospital environments were the main reservoir of nosocomial infection and provides critical information to guide the control of A. baumannii infection.

Geo-environmental parametric 3D models of SARS-CoV-2 virus circulation in hospital ventilation systems

The novel coronavirus, SARS-CoV-2, has the potential to cause natural ventilation systems in hospital environments to be rendered inadequate, not only for workers but also for people who transit through these environments even for a limited duration. Studies in of the fields of geosciences and engineering, when combined with appropriate technologies, allow for the possibility of reducing the impacts of the SARS-CoV-2 virus in the environment, including those of hospitals which are critical centers for healthcare. In this work, we build parametric 3D models to assess the possible circulation of the SARS-CoV-2 virus in the natural ventilation system of a hospital built to care infected patients during the COVID-19 pandemic. Building Information Modeling (BIM) was performed, generating 3D models of hospital environments utilizing Revit software for Autodesk CFD 2021. The evaluation considered dimensional analyses of 0°, 45°, 90° and 180°. The analysis of natural ventilation patterns on both internal and external surfaces and the distribution of windows in relation to the displacement dynamics of the SARS-CoV-2 virus through the air were considered. The results showed that in the external area of the hospital, the wind speed reached velocities up to 2.1 m/s when entering the building through open windows. In contact with the furniture, this value decreased to 0.78 m/s. In some internal isolation wards that house patients with COVID-19, areas that should be equipped with negative room pressure, air velocity was null. Our study provides insights into the possibility of SARS-CoV-2 contamination in internal hospital environments as well as external areas surrounding hospitals, both of which encounter high pedestrian traffic in cities worldwide.

Extensive outbreak of colistin resistant, carbapenemase (blaOXA-48, blaNDM) producing Klebsiella pneumoniae in a large tertiary care hospital, India

BACKGROUND

Extensive drug resistance in Klebsiella pneumoniae (K. pneumoniae) causing major outbreaks in large hospitals is an emerging challenge. We describe a near fatal outbreak of colistin resistant, carbapenem resistant K. pneumoniae (CRKp) producing metallo beta-lactamases (blaNDM) and blaOXA-48 in the neonatal intensive care unit (NICU) at the background of a larger outbreak involving multiple parts of the hospital and the challenges in its containment.

METHODS

Following identification of an outbreak due to colistin resistant CRKp between April to June 2017 in the NICU, a thorough surveillance of similar cases and the hospital environment was performed to trace the source. All the isolated K. pneumoniae were tested for susceptibility to standard antibiotics by disc diffusion and microbroth dilution methods. Molecular detection of extended spectrum beta lactamases (ESBLs) and carbapenemases (classes A, B, D) genes was done. Enterobacterial repetitive intergenic consensus (ERIC) PCR and multi-locus sequence typing (MLST) was done to determine the genetic relatedness of the isolates. Characteristics of different sequence types were statistically compared (Student's t-test).

RESULTS

A total of 45 K. pneumoniae isolates were studied from NICU (14 cases of neonatal sepsis), ICU (18 cases), other wards (7 cases) along with 6 isolates from hospital environment and human colonizers. The primary case was identified in the ICU. All the K. pneumoniae from NICU and 94.4% from the ICU were colistin resistant CRKp. Majority (59.37% and 56.25%) harbored blaSHV/blaCTXM and blaOXA-48 genes, respectively. Two distinct sequence types ST5235 and ST5313 were noted with colistin resistance, distribution within the NICU and mortality as significant attributes of ST5235 (p < 0.05). The outbreak was contained with strengthening of the infection control practices and unintended short duration closure of the hospital.

CONCLUSION

Large hospital outbreaks with considerable mortality can be caused by non-dominant clones of colistin resistant CRKp harboring blaOXA-48 and blaNDM carbapenemases in endemic regions. The exact global impact of these sequence types should be further studied to prevent future fatal outbreaks.

Aesthetics sets patients 'free' to recover during hospitalization with a neurological disease. A qualitative study

BACKGROUND

Patients with neurological symptoms are particularly sensitive to the quality of the sensory impressions to which they are exposed to during hospitalization.

AIM

To understand the meaning of aesthetic experiences to patients afflicted with neurological diseases during hospitalization on a neurological unit.

METHOD

Fifteen patients were invited to "walk and talk" supplemented by semi-structured interviews conducted in newly established aesthetic tableaus within the neurology unit. Data analysis was inspired by the hermeneutic phenomenological methodology of van Manen.

RESULT

The data analysis identified three overarching themes that unfolded in the patients' experiences of a more aesthetic environment. The themes were: 1) A safe place to avoid noisiness, 2) An invitation to homey activities, 3) A thoughtful consideration for being ill.

CONCLUSION

Aesthetic elements can enable a thoughtful and needed consideration that withholds momentarily imaginative and hopeful experiences to patients in a vulnerable situation. Thus, aesthetics, together with peace and quietness, can set vulnerable patients free to retreat and recover from the symptoms of neurological diseases.

Isolation and molecular identification of Acanthamoeba spp. from hospital dust and soil of Khomein, Iran, as reservoir for nosocomial infection

Background

Acanthamoeba spp. are commonest opportunistic amoebae, which ubiquitous in various environmental resources. Acanthamoeba species are the causative agents of amoebic keratitis, granulomatous amoebic encephalitis and i.e. in immunocompromised and immunocompetent patients. Moreover Acanthamoeba spp. can act as reservoir and transmission agent of bacterial pathogens. Due to this issue the aim of this study was to characterized Acanthamoeba spp. genotypes in dust and soil of hospital samples from Khomein of Iran.

Methods

In a cross sectional study, a total of 100 soil and dust samples were collected from hospital environment of Khomein Iran, and analyzed for the presence of Acanthamoeba spp. based on phenotypic and molecular methods including PCR amplification and sequence analysis of 18SrRNA. A total of 5 Acanthamoeba isolates were sequenced, and different genotypes of isolates were detected via direct sequence analysis.

Results

The results showed that 20% of samples (20/100) were positive for Acanthamoeba, while only 5 cases were successfully cultured in NNM medium and were subjected to molecular assay. A. lenticulata, A. castellanii and A. quina were the prevalent identified species that were belonged to T4 and T5 genotypes.

Conclusions

Acanthamoeba spp. are the most prevalent free living amoeba in the dust and soil of hospital environment. Moreover, due to the presence of potentially pathogenic T4 genotypes in our hospital, it is recommended that in health and hygienic programs elimination of FLA should be considered.

Development of a web-based contact tracing and point-of-care-testing workflow for SARS-CoV-2 at a German University Hospital

Introduction

In late 2019, a novel coronavirus was detected in China. Supported by its respiratory transmissibility, even by people infected without symptomatic disease, this coronavirus soon began to rapidly spread worldwide.

Background

Many countries have implemented different infection control and containment strategies due to ongoing community transmission. In this context, contact tracing as well as adequate testing and consequent quarantining of high-risk contacts play leading roles in containing the virus by interrupting infection chains. This approach is especially important in the hospital setting where contacts often cannot be avoided and physical distance is usually not possible. Furthermore, health care workers (HCWs) usually have contact with a variety of vulnerable people, making it essential to identify infections among hospital employees as soon as possible to interrupt the rapid spread of SARS-CoV-2 in the facility. Several electronic tools for contact tracing, such as specific software or mobile phone apps, are available for the public health sector. In contrast, contact tracing in hospitals often has to be carried out without helpful electronic tools, and an enormous amount of human resources is typically required.

Aim

For rapid contact tracing and effective infection control and management measures for HCWs in hospitals, adapted technical solutions are needed.

Methods

In this study, we report the development of our containment strategy to a web-based contact tracing and rapid point-of-care-testing workflow.

Results/conclusion

Our workflow yielded efficient control of the rapidly evolving situation during the SARS-CoV-2 pandemic from May 2020 until January 2021 at a German University Hospital.

Indoor air quality indicators and toxicity potential at the hospitals' environment in Dhaka, Bangladesh

Indoor air quality (IAQ) is a leading apprehension currently especially in the perilous atmosphere, like hospitals. Clean and fresh air is very crucial for the patients and healthcare professionals in the hospitals. Therefore, we examined IAQ indicators (PM_1.0, PM_2.5, PM₁₀, NO₂, CO₂, and TVOC) at sixteen locations of three hospitals with an emphasis on seasonal variations, indoor/outdoor correlation, and concomitant toxicity potential (TP) of human exposure between October 2019 and January 2020. For the measurement of trace gases (NO₂, CO₂, and TVOC), Aeroqual 500 series (New Zealand) sampler was used; particulate matter (PM_1.0, PM_2.5, and PM₁₀) concentrations and relative humidity (RH) were measured using the IGERESS air quality monitoring device (WP6930S, China). The total average concentration of IAQ indicators were 104.1 ± 67.6 (PM_1.0), 137.4 ± 89.2 (PM_2.5), and 159.0 ± 103.3 (PM₁₀) μgm^-3; 0.11 ± 0.02 (NO₂), 1047.1 ± 234.2 (CO₂), and 176.5 ± 117.7 (TVOC) ppm. Significant variations of IAQ indicators were observed between different locations of the hospitals. Winter IAQ indicators were much higher than post-monsoon season. Indoor particulate matter (PM) levels were lower than outdoor, but gaseous pollutants were higher in indoor than outdoor except NO₂. Indoor TVOC was about two times higher than outdoor and also higher in post-monsoon than winter. A good positive correlation was observed between indoor and outdoor particulate matter during winter. A strong positive correlation was obtained between NO₂ and RH with PM in winter. Very high (> 10) indoor toxicity potential (TP) values of PM_2.5 and PM₁₀ were determined during winter. Extremely high TP values indicated potential severe health consequences of the healthcare professionals and patients in indoor hospitals' environment.

Controlling bacteriological contamination of environmental surfaces at the biological isolation and containment unit of a veterinary teaching hospital

Background

The Biological Isolation and Containment Unit (BICU) is a subunit of the Teaching Hospital of the Faculty of Veterinary Medicine of the University of Lisbon, Portugal, for the admission of animals with confirmed infectious diseases or under clinical suspicion and waiting for a diagnosis. As a high-risk environment for the transmission of infectious agents, it is extremely important to implement programs for the surveillance of nosocomial microorganisms in these facilities. The purpose of this study was to evaluate the level of bacterial contamination of the BICU environmental surfaces and to implement corrective actions on disinfection protocols. Swab samples were collected from selected environmental surfaces in 3 different areas of the BICU (isolation, work, and preparatory rooms) to evaluate the total aerobic bacterial load and investigate the presence of 4 nosocomial microorganisms: vancomycin-resistant Enterococcus spp., methicillin-resistant Staphylococcus aureus, 3rd-generation cephalosporin-resistant Escherichia coli, and carbapenem-resistant Pseudomonas aeruginosa. Bacterial quantification was performed by using non-selective media, while specific selective media were used for the isolation of the target microorganisms. Isolates were identified based on their macro and microscopic characteristics and their biochemical profile. Subsequently, new disinfection protocols were implemented, and their effectiveness evaluated.

Results

The surfaces with the highest bacterial load in the isolation, preparatory, and worker’s rooms were the cages, hand-held sponge, and telephone, respectively. Regarding the 4 pathogens investigated, Enterococcus spp. were the most frequently isolated (11.3%), followed by E. coli (1.5%) and P. aeruginosa (1.5%). One of the P. aeruginosa isolates obtained was resistant to imipenem. In the end, new disinfection protocols were implemented, which proved to be effective in reducing bacterial counts by 99.99% in cages and the sponge, and by 90 to 99% on the telephone.

Conclusions

This study allows to conclude that the cages and the human contact surfaces were the most contaminated in the isolation rooms. Nevertheless, the new disinfection strategies seemed to be effective in reducing environmental contamination, including by some potentially nosocomial agents, although more samples must be analyzed for definitive conclusions. These results may contribute to highlight the importance of infection prevention and control measures, as fundamental tools to reduce the spread of infectious agents in the hospital environment.

Detection of Clostridioides difficile in hospital environment by using C diff Banana Broth™

116 environmental samples from a 504 bed clinical hospital obtained in 2017/19 were inoculated into C diff Banana Broth™. Six C. difficile and 12 C. pefringens strains were isolated. Antibiotic-resistant Clostridium spp. dominated in hospital environment. To determine Clostridium spp. in hospital environment suitable medium like C diff Banana Broth™ should be used.

Efficiency of an air circulation decontamination device for micro-organisms using ultraviolet radiation

BACKGROUND

The concern with environmental security to avoid contamination of individuals was intensified with the crisis established by SARS-CoV-2. The COVID-19 pandemic has shown the necessity to create systems and devices capable of clearing the air in an environment of micro-organisms more efficiently. The development of systems that allow the removal of micro-droplets mainly originating from breathing or talking from the air was the motivation of this study.

AIM

This article describes a portable and easy-to-operate system that helps to eliminate the droplets or aerosols present in the environment by circulating air through an ultraviolet-C (UV-C) reactor.

METHODS

An air circulation device was developed, and a proof-of-principle study was performed using the device against bacteria in simulated and natural environments. The microbiological analysis was carried out by the simple sedimentation technique. In order to compare the experimental results and the expected results for other micro-organisms, the reduction rate values for bacteria and viruses were calculated and compared with the experimental results based on technical parameters (clean air delivery rate (CADR) and air changes per hour (ACH)).

FINDINGS

Results showed that the micro-organisms were eliminated with high efficiency by the air circulation decontamination device, with reductions of 99.9% in the proof-of-principle study, and 84-97% in the hospital environments study, contributing to reducing contamination of individuals in environments considered to present risk.

CONCLUSION

This study resulted in a low-cost and relatively simple device, which was shown to be effective and safe, and could be replicated, especially in low-income countries, respecting the standards for air disinfection using UV-C technologies.

Fear of Hospital-Acquired Infections: The Combined Impact of Patient's Hygiene Sensitivity and Perceived Staff Preventive Behavior

Over the years, the public has paid growing attention to hospital-acquired infections (HAIs). Currently, infection prevention and control are considered a number one national priority in leading developed countries. However, while some hospital visitors are knowledgeable of the topic, others may be ignorant or careless as regards sterility and hygiene-related matters. This study, conducted in Israel, compared people cognizant of hygiene-related issues to those who are less so, in an attempt to account for differences in terms of attitudes and perceptions regarding the hospital environment. Based on Endsley's (in: Proceedings of the IEEE 1988 national aerospace and electronics conference, IEEE, 1988, 1995) situation awareness concept, we hypothesized that people attending the hospital with different hygiene schema would react differently when faced with HAI-related triggers. Based on a survey of 208 respondents, the results support the hypotheses, and showed a significant moderating effect of hygiene-sensitivity on the relationship between the staffs' hospital acquired infection-related proactive behavior and avoidance tendencies among hospital visitors. Theoretical as well as practical recommendations are discussed.

Environmental noise in hospitals: a systematic review

Environmental noise has been growing in recent years, causing numerous health problems. Highly sensitive environments such as hospitals deserve special attention, since noise can aggravate patients' health issues and impair the performance of healthcare professionals. This work consists of a systematic review of scientific articles describing environmental noise measurements taken in hospitals between the years 2015 and 2020. The researchers started with a consultation of three databases, namely, Scopus, Web of Science, and ScienceDirect. The results indicate that for the most part, these studies are published in journals in the fields of medicine, engineering, environmental sciences, acoustics, and nursing and that most of their authors work in the fields of architecture, engineering, medicine, and nursing. These studies, which are concentrated in Europe, the Americas, and Asia, use as reference values sound levels recommended by the World Health Organization. L_eq measured in hospital environments showed daytime values ranging from 37 to 88.6 dB (A) and nighttime values of 38.7 to 68.8 dB (A). L_eq values for outdoor noise were 74.3 and 56.6 dB (A) for daytime and nighttime, respectively. The measurements were taken mainly inside hospitals, prioritizing more sensitive departments such as intensive care units. There is a potential for growth in work carried out in this area, but research should also include discussions about guidelines for improvement measures aimed at reducing noise in hospitals.

Physiotherapy elastic band disinfection by UV-C irradiation in an intensive care unit

BACKGROUND

The transmission of healthcare-associated pathogens is mainly related to the massive flow of patients with infections in hospitals, presenting surfaces as potential transmission sources of these microorganisms. The physiotherapist who works in the intensive care area has become a specialist in daily routine in critical care with ventilatory support and post-surgical recovery. Furthermore, for this, the instruments are used in the patient's hands and body. Chemicals such as chlorine derivatives, triclosan, chlorhexidine and, 70 % alcohol are currently used to decontaminate surfaces. This study evaluated ultraviolet C (UV-C) irradiation efficiency in the physiotherapy object's disinfection in daily use in the Hospital Intensive Care Unit (ICU).

METHODS

the microbiological quantification carried out using the elastic band during physiotherapy in a cross-sectional study with 21 patients. The methodology compared the cleaning protocol (70 % alcohol) with a new irradiation method in elastic band in the ICU.

RESULTS

The results showed microbial reductions in the elastic band using both 70 % alcohol and UV-C irradiation (254 nm), with 60 s of illumination, totaling a light dose of 0.78 J/cm²; however, the UV-C irradiation showed better results.

CONCLUSION

This study showed that disinfection by UV-C irradiation could be introduced in an intensive care hospital environment for physiotherapeutic conduct.

Aptasensor for the detection of Methicillin resistant Staphylococcus aureus on contaminated surfaces

There is mounting evidence that contaminated hospital environment plays a crucial role in the transmission of nosocomial pathogens such as MRSA. The institution of infection control protocols is predicated on the early laboratory detection of the pathogen from relevant samples. Processing of environmental samples for the presence of bacterial contaminants in the clinical environment is poorly standardized when compared with analysis of clinical samples. The various laboratory methods available for processing environmental samples are difficult to standardized and most require a long turnaround time before results are available. In this study, we present a report of the performance of a novel pathogen aptasensor swab designed to qualitatively and quantitatively detect MRSA, on contaminated non-absorbable surfaces. The visual detection limit of the MRSA aptasensor swab was less than 100 CFU/ml and theoretically using a standard curve, was 2 CFU/ml. A relatively short turnaround time of 5 min was established for the assay while the linear range of quantitation was 10²-10⁵ CFU/ml. Engineered aptasensor targets MRSA selectively and binds to none of the other tested bacterial pathogen, on a multi-contaminated surface. This novel detection tool was easy to use and relatively cheap to produce.

Detection of influenza virus in air samples of patient rooms

BACKGROUND

Understanding the transmission and dispersal of influenza virus and respiratory syncytial virus (RSV) via aerosols is essential for the development of preventative measures in hospital environments and healthcare facilities.

METHODS

During the 2017-2018 influenza season, patients with confirmed influenza or RSV infections were enrolled. Room air samples were collected close (0.30 m) to and distant (2.20 m) from patients' heads. Real-time polymerase chain reaction was used to detect and quantify viral particles in the air samples. The plaque assay was used to determine the infectiousness of the detected viruses.

FINDINGS

Fifty-one air samples were collected from the rooms of 29 patients with laboratory-confirmed influenza; 51% of the samples tested positive for influenza A virus (IAV). Among the IAV-positive patients, 65% were emitters (had at least one positive air sample), reflecting a higher risk of nosocomial transmission compared with non-emitters. The majority (61.5%) of the IAV-positive air samples were collected 0.3 m from a patient's head, while the remaining IAV-positive air samples were collected 2.2 m from a patient's head. The positivity rate of IAV in air samples was influenced by distance from the patient's head and day of sample collection after hospital admission. Only three patients with RSV infection were recruited and none of them were emitters.

CONCLUSION

Influenza virus can be aerosolized beyond 1 m in patient rooms, which is the distance considered to be safe by infection control practices. Further investigations are needed to determine the extent of infectivity of aerosolized virus particles.

Species diversity and molecular analysis of opportunistic Mycobacterium, Nocardia and Rhodococcus isolated from the hospital environment in a developing country, a potential resources for nosocomial infection

Background

Hospital environmental resources have a significant role in cross-transmission of opportunistic pathogens such as actinomycetes species to the patients. Actinomycetes have a remarkable capability to survive in adverse and harsh conditions of hospital environments; therefore, they are a threat to the health of patients. Due to this issue, we aimed to determine the frequency and diversity of actinomycetes species in hospital soil, water and dust by using a combination of conventional and molecular methods including the phenotypic and biochemical tests for preliminary identification and the PCR amplification of the specific region of the 16S rRNA, hsp65 gene and sequence analyses of 16S rRNA for the genus and species identification.

Results

A total of 50 (35.2%) actinomycetes isolates from 7 genera were isolated from 142 hospital environmental samples. The three most prevalent species were M. setense 10%, R. erythropolis and M. fortuitum 8% followed by N.cyriacigeorgica and M. gordonae 6%, M. chelonae, M. abscessus, M. lentiflavum, M. mucogenicum, N. asteroides, N. farcinica, R. equi and L. shinushuensis 4% and the single isolates of M. conceptionense, M. septicum, N. rhamnosophilia, N. bravicatena, M. flavescens, M. arupense, M. doricum, M. frederiksbergense, S. heliomycini, S. albus, S. albogriseolus, R. facians, D. maris, G. terae and A. globiformis.

Conclusions

In conclusion we showed that the hospital environment is a potential reservoir for a broad range of actinomycetes species, due to the remarkable survival capability of these microorganisms in adverse hospital environment, carrying a threat to the health of patients.

Detection of influenza virus in air samples of patient rooms

BACKGROUND

Understanding the transmission and dispersal of influenza virus and respiratory syncytial virus (RSV) via aerosols is essential for the development of preventative measures in hospital environments and healthcare facilities.

METHODS

During the 2017-2018 influenza season, patients with confirmed influenza or RSV infections were enrolled. Room air samples were collected close (0.30 m) to and distant (2.20 m) from patients' heads. Real-time polymerase chain reaction was used to detect and quantify viral particles in the air samples. The plaque assay was used to determine the infectiousness of the detected viruses.

FINDINGS

Fifty-one air samples were collected from the rooms of 29 patients with laboratory-confirmed influenza; 51% of the samples tested positive for influenza A virus (IAV). Among the IAV-positive patients, 65% were emitters (had at least one positive air sample), reflecting a higher risk of nosocomial transmission compared with non-emitters. The majority (61.5%) of the IAV-positive air samples were collected 0.3 m from a patient's head, while the remaining IAV-positive air samples were collected 2.2 m from a patient's head. The positivity rate of IAV in air samples was influenced by distance from the patient's head and day of sample collection after hospital admission. Only three patients with RSV infection were recruited and none of them were emitters.

CONCLUSION

Influenza virus can be aerosolized beyond 1 m in patient rooms, which is the distance considered to be safe by infection control practices. Further investigations are needed to determine the extent of infectivity of aerosolized virus particles.

Becoming a nomad when hospitalized with a neurological disease: a phenomenological study

Patients with a neurological disease are affected by their ability to maintain focus and are easily disturbed by outside stimuli. Few studies have investigated how sensory impressions from the physical environment contribute to patient’s wellbeing during hospitalization. However, no studies have explored the meaning of the environment to patients with a neurological disease during hospitalization. To understand what it is like to be a patient in a hospitalized environment at the neurological department. Nine patients were interviewed. Data analysis was inspired by the hermeneutic phenomenological methodology of van Manen. Four themes were identified: Perceiving unrest leading to despair; Angling for attention from staff; Being in a vacuum of imposed passivity; Seeking breathing spaces. The study provides insight into how environment plays a significant role in relation to existential issues for patients during hospitalization. Hence, the patients illuminate the experience of becoming nomads lurking around to find breathing spaces when they were not offered a calm and familiar environment. Patients shared that a hospital interior can be appealing and uplifting, decreasing their experiences of placelessness and thereby supporting them in a life situation where they feel less threatened concerning their health and wellbeing.

Hospital environment as a reservoir for cross transmission: cleaning and disinfection procedures

BACKGROUND

Healthcare associated infections (HAIs) represent a serious problem for public health, as they increase the morbidity and mortality rates, present a relevant financial burden, and significantly contribute to the antimicrobial resistance.

METHODS

The aim of this review was to investigate the literature about HAIs, with particular reference to hospital environments and the role of cleaning and disinfection procedures. Hospital environments are an essential reservoir for HAIs cross transmission, and the application of appropriate procedures related to hand hygiene and disinfection/sterilization of surfaces and instruments remain key strategies for controlling HAIs.

RESULTS

Different procedures, based on the risk associated with the healthcare procedure, are recommended for hand hygiene: washing with soap and water, antiseptic rubbing with alcohol-based disinfectants, antiseptic and surgical hand washing. Environmental surfaces can be treated with different products, and the mostly used are chlorine-based and polyphenolic disinfectant. The reprocessing of instruments is related to their use according to the Spaulding's classification. In addition, scientific evidence demonstrated the great relevance of the "bundles" (small set of practices performed together) in controlling HAIs.

CONCLUSIONS

Research agenda should include the improvement of well-known effective preventive procedures and the development of new bundles devoted to high-risk procedures and specific microorganisms.

Outbreak of Ralstonia mannitolilytica bacteraemia in patients undergoing haemodialysis at a tertiary hospital in Pretoria, South Africa

Background

Ralstonia species are Gram-negative bacilli of low virulence. These organisms are capable of causing healthcare associated infections through contaminated solutions. In this study, we aimed to determine the source of Ralstonia mannitolilytica bacteraemia in affected patients in a haemodialysis unit.

Methods

Our laboratory noted an increase in cases of bacteraemia caused by Ralstonia mannitililytica between May and June 2016. All affected patients underwent haemodialysis at the haemodialysis unit of an academic hospital. The reverse osmosis filter of the haemodialysis water system was found to be dysfunctional. We collected water for culture at various points of the dialysis system to determine the source of the organism implicated. ERIC-PCR was used to determine relatedness of patient and environmental isolates.

Results

Sixteen patients were found to have Ralstonia mannitolilytica bacteraemia during the outbreak period. We cultured Ralstonia spp. from water collected in the dialysis system. This isolate and patient isolates were found to have the identical molecular banding pattern.

Conclusions

All patients were septic and received directed antibiotic therapy. There was 1 mortality. The source of the R. mannitolilytica infection in these patients was most likely the dialysis water as the identical organism was cultured from the dialysis water and the patients. The hospital management intervened and repaired the dialysis water system following which no further cases of R. mannitolilytca infections were detected. A multidisciplinary approach is required to control healthcare associated infections such as these. Routine maintenance of water systems in the hospital is essential to prevent clinical infections with R.mannitolilytica.

One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections

Despite improvements in hospital infection prevention and control, healthcare associated infections (HAIs) remain a challenge with significant patient morbidity, mortality, and cost for the healthcare system. In this review, we use a One Health framework (human, animal, and environmental health) to explain the epidemiology, demonstrate key knowledge gaps in infection prevention policy, and explore improvements to control Gram-positive pathogens in the healthcare environment. We discuss patient and healthcare worker interactions with the hospital environment that can lead to transmission of the most common Gram-positive hospital pathogens – methicillin-resistant Staphylococcus aureus, Clostridioides (Clostridium) difficile, and vancomycin-resistant Enterococcus – and detail interventions that target these two One Health domains. We discuss the role of animals in the healthcare settings, knowledge gaps regarding their role in pathogen transmission, and the absence of infection risk mitigation strategies targeting animals. We advocate for novel infection prevention and control programs, founded on the pillars of One Health, to reduce Gram-positive hospital-associated pathogen transmission.

Factors influencing sleep quality among Jordanian intensive care patients

Sleep disturbance is common in patients in the intensive care unit (ICU). Numerous factors can contribute to this. High noise and light levels, nursing interventions and medication administration are major factors. This study investigated the demographic and environmental factors that might adversely affect ICU patients' quality of sleep. Data were collected from 103 patients using a demographic data sheet, the Freedman Quality of Sleep Scale and the Richards-Campbell Sleep Scale. Patients' demographic characteristics were found to have no significant effects on their perceived quality of sleep. Environmental factors, including noise, light, nursing interventions, diagnostic testing, the administration of medication, talking and phones ringing, were significantly related to the patients' perceived quality of sleep.

A hospital recreation room quality improvement intervention

PURPOSE

Patients with extended hospital admissions had no recreation facilities in the ward. They were often confined to spaces around their beds, using the ward corridor for rehabilitation. The purpose of this paper is to outline a quality improvement (QI) intervention-provision of a recreational space for long-stay patients.

DESIGN/METHODOLOGY/APPROACH

An exploratory quantitative pre-, post-test design was utilised, and executed in three phases: patients, visitors and staff survey to explore recreation and comfort needs and preferences; store room refurbishment; and patient, visitor and staff satisfaction with the recreation room.

FINDINGS

Overall, 77 questionnaires were completed (n=49 staff; n=28 patient/visitor). Almost two-thirds (64.7 per cent; n=11) of patients had a stay greater than six weeks. Insufficient private space and concerns about disturbing other patients were identified as barriers to taking part in activities. Consequently, a store room was refurbished as a recreation room (9.0 m × 6.0 m) and furnished in three distinct areas. Following refurbishment, over 90 per cent (n=24) of respondents agreed that there was a suitable space where patients could "go and chat" and spend time with family and visitors or speak to the healthcare team.

PRACTICAL IMPLICATIONS

The physical environment in acute hospitals is seldom prioritised. Needs-based QI projects can improve patient hospital experiences.

ORIGINALITY/VALUE

This case study highlights how nursing staff can be informed by patients' and families' needs and preferences, and initiate QI projects that improve patient hospital experiences.

Application of nutrient profile models to compare products offered in 'healthy' vs 'conventional' vending machines in a Spanish hospital environment

INTRODUCTION

Vending machines promote easy access to food with low nutritional value. 'Healthy' vending machines (HVM) have been introduced as a means to improve the availability and accessibility of healthy food options, and the healthiness of the foods, however, has not been evaluated.

OBJECTIVE

Our aim was to assess the healthiness of the products offered in HVM and 'conventional' vending machines (CVM), located in the Catalan Institute of Oncology.

STUDY DESIGN AND METHODS

All products available in vending machines (HVM (n = 33) and CVM (n = 62) were evaluate during three nutrient profile models (NPMs): the World Health Organization's European Regional Office model (WHO), Nutrient Profile Model UK (NPM-UK), and Australian Health Star Rating system (HSR).

RESULTS

Regardless of the NPM used, significant differences found in the proportion of healthy products among HVM and CVM (WHO: P-value = 0.005, NPM-UK: P value < 0.001, HSR: P-value < 0.001). The healthy products offered in HVM accounted for 30%, 73%, and 52% of the total content, while CVM offered 6%, 32%, and 15% of the content, as assessed by WHO, NPM-UK, and HSR, respectively. The WHO model was the most restrictive model, and the NPM-UK was the most permissible one.

CONCLUSIONS

Although not all products in HVM are rated as healthy by the different NPMs, the percentage of healthy products was significantly higher than those in CVM.

Comparative evaluation of a novel fluorescent marker and environmental surface cultures to assess the efficacy of environmental cleaning practices at a tertiary care hospital

BACKGROUND

Cleaning high-touch surfaces serves as a crucial step towards controlling the transmission of multidrug-resistant pathogens in hospital environments. The process can be made most effective if scientifically monitored using a simple, feasible and reliable technique, especially in resource-poor settings.

AIM

To identify a novel florescent marker (FM) comparable to the already existing commercial FM systems and to assess its efficacy in evaluating cleaning of high-touch surfaces in a hospital environment.

METHODS

A liquid detergent used for washing purposes was identified as a novel FM. Pre- and post-cleaning sampling were performed from 250 high-touch surfaces in different patient-care areas using this marker and aerobic colony counts. Concordance between the two methods was assessed and compared by Cohen's kappa coefficient. The sensitivity, specificity, positive predictive and negative predictive values for the new FM method were calculated against the microbiological method.

FINDINGS

A good correlation (κ = 0.60) with overall concordance of 79.6% was observed between the two methods. The sensitivity, specificity, positive predictive value and negative predictive value of the FM were 79.58% (95% confidence interval (CI): 72-85.85%), 79.63% (95% CI: 70.79-86.78), 83.70% (95% CI: 76.38-89.50) and 74.78% (95% CI: 65.83-82.38), respectively.

CONCLUSIONS

The FM used in the present study proved to be a simple and cost-effective alternative to commercially available FMs for assessing environmental cleaning practices on a daily basis in resource-poor settings. Additional studies making direct comparisons of the FM used here with the established FMs are warranted before it can be generalized for use.

[Bacteriocidal effects of introducing copper products on highly touched areas in hematology ward]

Nosocomial infection via the hospital environment is a serious problem, and highly touched surfaces are the main route of transmission. Copper has been reported to possess bacteriocidal effects, and the introduction of copper-impregnated products is receiving attention as a potential component of hospital infection control. In this study, copper-impregnated door handles as highly touched areas were introduced in a hematology ward, and their bacteriocidal effects were evaluated in comparison with conventional products. All 12 samples obtained from conventional door handles were positive for bacterial cultures, whereas only 5 of 18 samples from copper-impregnated handles were positive (P<0.0001). The mean number of bacterial colonies per milliliter of sample was 300 (range: 40-1.1×10⁶) in samples from conventional handles, but it was significantly lower in samples from copper-impregnated handles (0; range: 0-220, P<0.0001). While various types of bacteria grew on conventional handles, most of the bacteria on copper-impregnated handles were Bacillus subtilis. These results suggest that the introduction of copper-impregnated products would be useful for hospital infection control by reducing the bacterial burden on highly touched areas. However, the efficacy of this approach against spore-forming bacteria should be further investigated.

[Ametropia among senegalese children in a hospital setting]

INTRODUCTION

Ametropia is common in children and cause strabismus and amblyopia. The goal was to establish its prevalence in a hospital setting among Senegalese children.

PATIENTS AND METHODS

This was a retrospective study of patients under 15 years of age with clear ocular media. The marital status, circumstances of discovery, and results of cycloplegic refraction were recorded.

RESULTS

Of 1506 children, 175 demonstrated ametropia. The mean age was 8 years, and the male : female ratio was 0.68. Family history of ametropia was present in 8.5 %. Decreased VA was present in 39.66 %, headache 10.06 %, and strabismus 4.47 %. Automated refraction in 109 patients and skiascopy in one patient showed 58.18 % cases of myopia, 18.18 % of hyperopia and 36.57 % of astigmatism.

DISCUSSION

The most common ametropia was myopia. Patients were referred for symptomatic ametropia.

CONCLUSION

Screening for ametropia might occur earlier if it is associated with pediatric monitoring in our regions.

Characterization of Clostridioides difficile isolates recovered from hospitalized patients and the hospitals environment and air: A multicenter study

In healthcare settings, contamination of environment with toxigenic and hypervirulent Clostridioides difficile strains is a serious concern. Here, we assessed whether patients with C. difficile have a role to play in the dissemination of C. difficile in our settings or other sources are implicated in its circulation. A total of 700 fecal specimens and 1435 environmental samples from surfaces, equipment and air of rooms occupied by patients suspected of C. difficile infection were taken from 4 tertiary hospitals in Tehran, Iran between April 2016 and August 2017. Antibiotic susceptibility testing and detection of resistance genes were performed for the environmental isolates. The clinical and environmental isolates of C. difficile were subjected to Pulsed Field Gel Electrophoresis (PFGE) analysis. Forty three (6.14%) and 2 (0.13%) isolates of C. difficile were recovered from the clinical and environmental samples, respectively. In the clinical settings, 2 patients were suspected of recurrent C. difficile infection. Thirty distinct pulsotypes were found among the C. difficile isolates including 28 singletons and 2 common types. One of the two environmental isolates was isolated from floor in the Medical ward, of pulsotype/ribotype/toxinotype PT10/New ribotype/toxinotype V, harbored cdtA/B and tcdC-A, and resistant to ciprofloxacin. The other one was isolated from air of a room in ICU, assigned to PT11/RT001/toxinotype 0, belonged to tcdC-sc3 genotypes and resistant to metronidazole. The environmental isolates did not generate amplicons in PCR assays targeting vanA and nim genes. This study provided evidence for dissemination of genetically diverse strains of C. difficile in hospitalized patients, presence of C. difficile in hospital air, existence of binary toxin positive/antibiotic-resistant isolate on the floor and intra-hospital dissemination of this pathogen.

Healthcare-associated infections: bacteriological characterization of the hospital surfaces in the University Hospital of Abomey-Calavi/so-ava in South Benin (West Africa)

Background

Healthcare-associated infections have become a public health problem, creating a new burden on medical care in hospitals. The emergence of multidrug-resistant bacteria poses a difficult task for physicians, who have limited therapeutic options. The dissemination of pathogens depends on “reservoirs”, the different transmission pathways of the infectious agents and the factors favouring them. Contaminated environmental surfaces are an important potential reservoir for the transmission of many healthcare-associated pathogens. Pathogens can survive or persist in the environment for months and be a source of infection transmission when appropriate hygiene and disinfection procedures are inefficient. The aim of this study was to identify bacterial species from hospital surfaces in order to effectively prevent healthcare-associated infections.

Methods

Samples were taken from surfaces at the University Hospital of Abomey-Calavi/So-Ava in South Benin (West Africa). To achieve the objective of this study, 160 swab samples of hospital surfaces were taken as recommended by the International Organization for Standardization (ISO 14698-1). These samples were analysed in the bacteriology section of the National Laboratory for Biomedical Analysis. All statistical analyses were performed using SPSS Statistics 21 software. A Chi Square Test was used to test the association between the Results of culture samples and different care units.

Results

Of the 160 surface samples, 65% were positive for bacteria. The frequency of isolation was predominant in Paediatrics (87.5%). The positive samples were 64.2% Gram-positive bacteria and 35.8% of Gram-negative bacteria. Staphylococcus aureus predominated (27.3%), followed by Bacillus spp. (23.3%).

The proportion of other microorganisms was negligible. S. aureus and Staphylococcus spp. were present in all care units. There was a statistically significant association between the Results of culture samples and different care units (χ2 = 12.732; p = 0.048).

Conclusion

The bacteria found on the surfaces of the University Hospital of Abomey-Calavi/So-Ava’s care environment suggest a risk of healthcare-associated infections. Adequate hospital hygiene measures are required. Patient safety in this environment must become a training priority for all caregivers.

An Innovative Strategy for the Effective Reduction of MDR Pathogens from the Nosocomial Environment

Antimicrobial resistance (AMR) is currently one of the main concerns for human health.Due to its rapid increase and global diffusion, several common microbial infections might become not curable in the future decades, making it impossible to apply other lifesaver therapies, such as transplant or chemotherapy.AMR is frequently observed in hospital pathogens, due to selective pressure exerted by antibiotic use, and consistently with this, in the recent years, many actions have been proposed to limit AMR spread, including hygiene measures for hospital professionals and a wiser antibiotic usage.Indeed, the hospital environment itself represents a reservoir of pathogens, whose control was so far addressed by conventional sanitation procedures, which however cannot prevent recontamination and might further favour the selection of resistant strains.Here we report the results collected by studying an innovative sanitation strategy based on the use of probiotic bacteria, capable of reducing in a stable way the surface load of pathogens and their AMR. Collected data suggest that this system might contribute significantly to AMR control and might be thus considered as one of the tools for AMR and infection prevention and control.

Analysis of differences in subjective health status according to characteristics of hospitalized cancer patients

This study is intended to analyze differences in the self-rated health of patients according to the characteristics of hospitalized cancer patients. To this end, this study analyzed the differences in self-rated health according to cancer diagnosis type, cancer stage and adjunctive treatment and analyzed the recognition of difficulties in physical activities during hospitalization. A questionnaire survey was conducted among data of 162 hospitalized cancer patients. For the self-rated health of cancer patients according to diagnosis type, it was lower in the gastric cancer group than in the thyroid cancer group and the breast cancer group. For self-rated health according to cancer stage, it was higher in the order of the stage 3 group, stage 2 group and stage 1 group. For the self-rated health of patients receiving adjunctive treatment, it was the lowest in the chemotherapy+radiotherapy group. And for personal constraints according to cancer stage in the category of “physical,” it was higher in the stage 3 group than in the stage 1 group. For hospital environment restrictions according to cancer stage in the category of “tool,” it was higher in the stage 1 group than in the stage 3 group. In conclusion, personal constraints on the physical activities of cancer patients appear to be due to fatigue and a lack of motivation, but medical services that influence motivation are critical to individual and continued care strategies for the patients.

Multidrug-resistant Acinetobacter baumannii clones persist on hospital inanimate surfaces

Acinetobacter baumannii is one of the most frequent Gram-negative opportunistic pathogens associated with hospital-acquired infection worldwide. We briefly describe A. baumannii isolates that were recovered from surrounding ICU bed surfaces, exhibiting multidrug resistance phenotype and belonging to some widely spread clonal complexes of clinical A. baumannii isolates.

Inactivation of multidrug-resistant pathogens and Yersinia enterocolitica with cold atmospheric-pressure plasma on stainless-steel surfaces

The objective of this study was to investigate the impact of cold atmospheric-pressure plasma (CAP) produced by a surface micro-discharge plasma source as a new strategy to combat the transmission of five multidrug-resistant (MDR) pathogens and Yersinia enterocolitica on typical hospital- and food-producing surfaces, e.g. stainless-steel. Approximately 10⁶ CFU/cm² of vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Y. enterocolitica were inoculated on a 3.14-cm² stainless-steel surface. Bovine serum albumin (BSA) (3%) was used as a disruptive factor simulating natural organic material. The inoculated surfaces were subsequently exposed to CAP, generated by a peak-to-peak voltage of 10 kV with sinusoidal waveform and a frequency of 2 kHz, for 5, 10 and 20 min, respectively. Fluorescent staining with propidium iodide and SYTO^TM 9 was used to demonstrate the manner of bacterial cell damage. Significant (P < 0.05) inactivation of 1.68 ± 0.17 up to 2.80 ± 0.17 log steps was achieved after 5 min of CAP treatment. However, bacterial reduction could be increased to 3.35 ± 0.1 up to 5.17 ± 0.67 log steps after 20 min of CAP treatment. Bacterial cells covered with BSA were statistically significantly less inactivated by CAP. Fluorescent staining showed a predominant level of orange-stained, sublethally damaged bacterial cells after 10 min of CAP treatment. In conclusion, CAP has the ability to inactivate MDR bacterial pathogens on stainless-steel surfaces. Further research is required to investigate the clinical features of CAP.

The Role of Environmental Contamination in the Transmission of Nosocomial Pathogens and Healthcare-Associated Infections

PURPOSE OF REVIEW

The aim of this review is to highlight the role of environmental contamination in healthcare-associated infections (HAIs) and to discuss the most commonly implicated nosocomial pathogens.

RECENT FINDINGS

Recent studies suggest that environmental contamination plays a significant role in HAIs and in the unrecognized transmission of nosocomial pathogens during outbreaks, as well as ongoing sporadic transmission. Several pathogens can persist in the environment for extended periods and serve as vehicles of transmission and dissemination in the hospital setting. Cross-transmission of these pathogens can occur via hands of healthcare workers, who become contaminated directly from patient contact or indirectly by touching contaminated environmental surfaces. Less commonly, a patient could become colonized by direct contact with a contaminated environmental surface. This review describes the role of environmental contamination in HAIs and provides context for reinforcing the importance of hand hygiene and environmental decontamination for the prevention and control of HAIs.

Is there an association between airborne and surface microbes in the critical care environment?

BACKGROUND

There are few data and no accepted standards for air quality in the intensive care unit (ICU). Any relationship between airborne pathogens and hospital-acquired infection (HAI) risk in the ICU remains unknown.

AIM

First, to correlate environmental contamination of air and surfaces in the ICU; second, to examine any association between environmental contamination and ICU-acquired staphylococcal infection.

METHODS

Patients, air, and surfaces were screened on 10 sampling days in a mechanically ventilated 10-bed ICU for a 10-month period. Near-patient hand-touch sites (N = 500) and air (N = 80) were screened for total colony count and Staphylococcus aureus. Air counts were compared with surface counts according to proposed standards for air and surface bioburden. Patients were monitored for ICU-acquired staphylococcal infection throughout.

FINDINGS

Overall, 235 of 500 (47%) surfaces failed the standard for aerobic counts (≤2.5 cfu/cm²). Half of passive air samples (20/40: 50%) failed the 'index of microbial air' contamination (2 cfu/9 cm plate/h), and 15/40 (37.5%) active air samples failed the clean air standard (<10 cfu/m³). Settle plate data were closer to the pass/fail proportion from surfaces and provided the best agreement between air parameters and surfaces when evaluating surface benchmark values of 0-20 cfu/cm². The surface standard most likely to reflect hygiene pass/fail results compared with air was 5 cfu/cm². Rates of ICU-acquired staphylococcal infection were associated with surface counts per bed during 72h encompassing sampling days (P = 0.012).

CONCLUSION

Passive air sampling provides quantitative data analogous to that obtained from surfaces. Settle plates could serve as a proxy for routine environmental screening to determine the infection risk in ICU.

Distribution, genetic diversity and antimicrobial resistance of clinically important bacteria from the environment of a tertiary hospital in Malaysia

OBJECTIVES

Hospital environments are potential reservoirs of bacteria associated with nosocomial infections. In this study, the distribution of cultivable environmental bacteria of clinical importance from a Malaysian tertiary hospital was determined and their resistotypes and genotypes were investigated.

METHODS

Swab and fluid samples (n=358) from healthcare workers' hands, frequently touched surfaces, medical equipment, patients' immediate surroundings, ward sinks and toilets, and solutions or fluids of 12 selected wards were collected. Biochemical tests, PCR and 16S rRNA sequencing were used for identification following isolation from CHROMagar™ Orientation medium. Clinically important bacteria such as Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter spp., Pseudomonas aeruginosa and Enterobacter spp. were further characterised by disc diffusion method and rep-PCR.

RESULTS

The 24 Gram-negative and 19 Gram-positive bacteria species identified were widely distributed in the hospital environment. Staphylococci were predominant, followed by Bacillus spp. and P. aeruginosa. Frequently touched surfaces, medical equipment, and ward sinks and toilets were the top three sources of bacterial species. Nine S. aureus, four Acinetobacter spp., one K. pneumoniae and one Enterobacter spp. were multidrug-resistant (MDR). The ESKAPE organisms were genetically diverse and widely dispersed across the hospital wards. A MDR MRSA clone was detected in a surgical ward isolation room.

CONCLUSION

The large variety of cultivable, clinically important bacteria, especially the genetically related MDR S. aureus, K. pneumoniae, Acinetobacter spp. and Enterobacter spp., from various sampling sites indicated that the surfaces and fomites in the hospital were potential exogenous sources of nosocomial infection in the hospital.

Antimicrobial effect of copper alloys on Acinetobacter species isolated from infections and hospital environment

Background

An increased proportion of Gram-negative bacteria have recently been reported among etiologic agents of infection. In Poland, Acinetobacter baumannii is a big problem for hospitals, especially intensive care units. Touch surfaces made from materials with antimicrobial properties, especially copper alloys, are recommended as a supplementary method of increasing biological safety in the hospital environment.

Aim of the study

The objective of this study is to determine the susceptibility to selected copper alloys of three clinical Acinetobacter baumannii strains, one Acinetobacter lwoffi and an A. pittii strain isolated from the hospital environment.

Material and method

The modification of the Japanese Standard, which the ISO 22196:2011 norm was used for testing antimicrobial properties of CuZn37, CuSn6 and CuNi18Zn20 and Cu-ETP and stainless steel as positive and negative control, respectively.

Results

The highest cidal efficiency, expressed as both time and the degree of reduction of the initial suspension density, against all of the tested Acinetobacter strains was found for ETP copper. But, the results of our study also confirmed effective activity (bacteriocidal or bacteriostatic) of copper alloys selected for the study, contrary to the stainless steel. The reduction in bacterial suspension density is significantly different depending on the strain and copper alloy composition.

Conslusions

The results of our study confirmed the effective antibacterial activity of copper and its selected alloys against clinical Acinetobacter baumannii and Acinetobacter lwoffii strains, and Acinetobacter pittii strain isolated from the hospital environment.

No apparent transmission of livestock-associated methicillin-resistant Staphylococcus aureus CC398 in a survey of staff at a regional Danish hospital

Background

In recent years, livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) multi locus sequence type CC398 has spread widely in the livestock production in Europe. The rates of LA-MRSA in hospitals have been found to be largely determined by contact to and density of livestock in the area.

Methods

This is a cross sectional study of the prevalence of LA-MRSA among hospital staff in a Danish hospital situated in a livestock production region. We analysed nasal swabs, air and dust samples for the presence of MRSA using PCR and mass spectrometry.

Results

Of 1745 employees, 545 (31%) contributed nasal swabs. MRSA was not detected in any participant, nor was it detected in air or dust at the hospital or in houses of employees living on farms. Four percent of the participants had contact to pigs either directly or through household members. LA-MRSA was detected in two of 26 samples from animal sheds, both of them from pig farms. The participation rate was relatively low, but participants were representative for the source population with regards to animal contact and job titles.

Conclusions

The study suggests a low point prevalence of LA-MRSA carriage in Danish hospital staff even in regions where livestock production is dense. Should more studies confirm our findings we see no need for additional hospital precautions towards LA-MRSA in Denmark at the moment. We think that our data might reduce potential stigmatization of hospital workers with contact to LA-MRSA positive farms at their work places and in their communities.

Electronic supplementary material

The online version of this article (10.1186/s13756-017-0284-y) contains supplementary material, which is available to authorized users.

Environmental cleaning and disinfection of patient areas

The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients. Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections. While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources.

Genotypic diversity among multidrug resistant Pseudomonas aeruginosa and Acinetobacter species at Mulago Hospital in Kampala, Uganda

BACKGROUND

Multidrug resistant Pseudomonas aeruginosa and Acinetobacter species are common causes of nosocomial infections worldwide. Recently we reported the occurrence of carbapenem resistant Enterobacteriaceae, P. aeruginosa and Acinetobacter species at Mulago National Referral Hospital in Kampala, Uganda, but the isolates were not analyzed for genetic relatedness. Herein we report the intra-species genotypic diversity among P. aeruginosa and Acinetobacter baumannii isolated from hospitalized patients and the environment at Mulago Hospital, using repetitive elements-based PCR (Rep-PCR) genotyping.

RESULTS

A total of 736 specimens from hospitalized patients were processed for culture and sensitivity testing yielding 9 (1.2%) P. aeruginosa and 7 (0.95%) A. baumannii. Similarly, 100 samples from the hospital environment were processed yielding 33 (33%) P. aeruginosa and 13 (13%) A. baumannii. Altogether, 62 non-repetitive isolates were studied (42 P. aeruginosa and 20 A. baumannii), of which 38% (16/42) P. aeruginosa and 40% (8/20) A. baumannii were multidrug resistant (isolates resistant to three or more classes of antimicrobials). Carbapenem resistance prevalence was 33 and 21% for P. aeruginosa from patients and the environment, respectively, while it was 14 and 86% for A. baumannii from patients and environment, respectively. Cluster analysis of the Rep-PCR fingerprints revealed a high level of genetic diversity among the isolates within each species as few isolates were clustered (at 100% level of similarity). More to this, the clustered isolates revealed a complex nature of multidrug resistant P. aeruginosa and A. baumannii clones circulating at Mulago Hospital. Importantly, certain isolates from the environment and patients were clustered, implying that hospitalized patients at Mulago were probably infected with strains from the environment.

CONCLUSIONS

The prevalence of multidrug resistant P. aeruginosa and A. baumannii is high at Mulago Hospital but carbapenem resistance prevalence remains relatively low in isolates from hospitalized patients. Importantly, the prevalence of carbapenem resistance in isolates from the environment is high implying the infection control practices at the hospital might be inadequate.

Hospital microbial surface colonization revealed during monitoring of Klebsiella spp., Pseudomonas aeruginosa, and non-tuberculous mycobacteria

Hospital environmental conditions, human occupancy, and the characteristics of the equipment influence the survival of microbial communities and raise a concern with regard to nosocomial infections. The objective of the present work was to use the monitoring of Pseudomonas aeruginosa, Klebsiella spp. and non-tuberculous mycobacteria as a strategy to improve knowledge on microbial colonization of non-critical equipment and surfaces, in a tertiary hospital from Central Portugal. A 3-month microbiological survey was performed in a district teaching hospital. A total of 173 samples were obtained from the wards Hematology, Urology, Medicine, and Renal Transplants, and 102 presumptive strains recovered. Per sampling, Pseudomonas Isolation agar showed 42.8 to 73.3% of presumptive P. aeruginosa colonies and MacConkey agar recovered mostly Staphylococcus. Most of the colonies recovered in Middlebrook 7H10-PANTA belonged to the genus Methylobacterium. Taps and WC shower curtains carry high bacterial species diversity. The Redundancy Analysis grouped the samples in those mostly handled by patients, and those mostly handled by healthcare staff or of mixed use. This study shows that the preferential users of the space and equipment seem to be important contributors to the microbial community. The most recovered genus was Methylobacterium, known as colonizer of the water distribution system therefore, it is possible that the water points and biofilms in taps also contribute as dispersion hotspots.

Comparison of 16S ribosomal RNA gene sequence analysis and conventional culture in the environmental survey of a hospital

Background

Nosocomial infection is one of the most common complications within health care facilities. Certain studies have reported outbreaks resulting from contaminated hospital environments. Although the identification of bacteria in the environment can readily be achieved using culturing methods, these methods detect live bacteria. Sequencing of the 16S ribosomal RNA (16S rRNA) gene is recognized to be effective for bacterial identification. In this study, we surveyed wards where drug-resistant bacteria had been isolated and compared conventional culture methods with 16S rRNA gene sequencing methods.

Methods

Samples were collected using sterile swabs from two wards (northern and southern) at Gunma University Hospital contaminated by Acinetobacter sp.. We extracted DNA directly from the swabs. Following extraction, the DNA was amplified using polymerase chain reaction (PCR). The PCR products were cloned using the plasmid vector. The plasmid DNA were sequenced, and identification were performed using database. 16S rRNA gene sequence analyses were compared conventional culture methods.

Results

In the northern ward, Acinetobacter sp. was detected from only two of 14 samples using the culture method. In contrast, 16S rRNA gene sequencing analysis detected Acinetobacter sp. from seven of 14 samples. Drug-resistant Acinetobacter sp. was isolated from bathrooms of the southern ward and was detected from four of seven samples using the culture method in comparison with six of seven samples by 16S rRNA gene sequencing analysis.

Conclusions

Molecular biological analysis showed a higher sensitivity to detect specific bacteria and detected a greater number of species than the culture method. Our results suggest that 16S rRNA gene sequencing analysis is useful to identify range of contamination which were not found in conventional culture method. When a nosocomial outbreak cannot be adequately controlled, molecular biological analysis may serve as a useful tool for environmental surveys in hospitals.

Molecular epidemiology of environmental and clinical carbapenemase-producing Gram-negative bacilli from hospitals in Guelma, Algeria: Multiple genetic lineages and first report of OXA-48 in Enterobacter cloacae

This study was designed to investigate environmental colonisation in Algerian hospitals by carbapenem-resistant Gram-negative bacilli (GNB), including molecular characterisation of their resistance, and to perform a comparative molecular analysis between clinical and environmental strains. GNB isolated from hospitalised patients and the hospital environment were identified using microbiological methods and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). Antibiotic susceptibility testing was performed by disk diffusion and Etest methods. Carbapenemase- and extended-spectrum β-lactamase (ESBL)-encoding genes were searched for using PCR and sequencing. Clonality of the environmental and clinical strains was assessed by multilocus sequencing typing (MLST). A total of 32 carbapenem-resistant GNB were isolated, including 16 (29%) of 56 multidrug-resistant (MDR) GNB from clinical specimens and 16 (48%) of 33 MDR-GNB from inanimate surfaces. Of the 32 carbapenem-resistant isolates, 14 produced a carbapenemase. The bla_OXA-48 gene was detected both in clinical and surface isolates of Klebsiella pneumoniae (n=3) and Enterobacter cloacae (n=2). Clinical and surface isolates of Acinetobacter baumannii were found to produce the carbapenemases NDM-1 (7 isolates) and OXA-23 (2 isolates). MLST revealed clonal diversity and a relationship between environmental and clinical strains with identical sequence types. Here we report the first description of an OXA-48-producing E. cloacae isolate in Algeria. We also highlight the important role of inanimate surfaces in the spread of carbapenem-resistant bacteria and the emergence of nosocomial infections.

Route complexity and simulated physical ageing negatively influence wayfinding

The aim of this age-simulation field experiment was to assess the influence of route complexity and physical ageing on wayfinding. Seventy-five people (aged 18-28) performed a total of 108 wayfinding tasks (i.e., 42 participants performed two wayfinding tasks and 33 performed one wayfinding task), of which 59 tasks were performed wearing gerontologic ageing suits. Outcome variables were wayfinding performance (i.e., efficiency and walking speed) and physiological outcomes (i.e., heart and respiratory rates). Analysis of covariance showed that persons on more complex routes (i.e., more floor and building changes) walked less efficiently than persons on less complex routes. In addition, simulated elderly participants perform worse in wayfinding than young participants in terms of speed (p < 0.001). Moreover, a linear mixed model showed that simulated elderly persons had higher heart rates and respiratory rates compared to young people during a wayfinding task, suggesting that simulated elderly consumed more energy during this task.

Carbapenem resistant Pseudomonas aeruginosa and Acinetobacter baumannii at Mulago Hospital in Kampala, Uganda (2007-2009)

Background

Multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii are common causes of health care associated infections worldwide. Carbapenems are effective against infections caused by multidrug resistant Gram-negative bacteria including Pseudomonas and Acinetobacter species. However, their use is threatened by the emergence of carbapenemase-producing strains. The aim of this study was to determine the prevalence of carbapenem-resistant P. aeruginosa and A. baumannii at Mulago Hospital in Kampala Uganda, and to establish whether the hospital environment harbors carbapenem-resistant Gram-negative rods.

Results

Between February 2007 and September 2009, a total of 869 clinical specimens were processed for culture and sensitivity testing yielding 42 (5 %) P. aeruginosa and 29 (3 %) A. baumannii isolates, of which 24 % (10/42) P. aeruginosa and 31 % (9/29) A. baumannii were carbapenem-resistant. Additionally, 80 samples from the hospital environment were randomly collected and similarly processed yielding 58 % (46/80) P. aeruginosa and 14 % (11/80) A. baumannii, of which 33 % (15/46) P. aeruginosa and 55 % (6/11) A. baumannii were carbapenem-resistant. The total number of isolates studied was 128. Carbapenemase genes detected were bla_IMP-like (36 %, 9/25), bla_VIM-like (32 %, 8/25), bla_SPM-like (16 %, 4/25); bla_NDM-1-like (4 %, 1/25) in carbapenem-resistant P. aeruginosa, and bla_OXA-23-like (60 %, 9/15), bla_OXA-24-like (7 %, 1/15), bla_OXA-58-like (13 %, 2/15), and bla_VIM-like (13 %, 2/15) in carbapenem-resistant A. baumannii. Furthermore, class 1 integrons were detected in 38 % (48/128) of P. aeruginosa and Acinetobacter, 37 % (26/71) of which were in clinical isolates and 39 % (22/57) in environment isolates. Gene cassettes were found in 25 % (12/48) of integron-positive isolates. These were aminoglycoside adenylyltransferase ant(4′)-IIb (3 isolates); trimethoprim-resistant dihydrofolate reductase dfrA (2 isolates); adenyltransferase aadAB (3 isolates); QacE delta1 multidrug exporter (2 isolates); quinolone resistance pentapeptide repeat protein qnr (1 isolate); and metallo-β-lactamase genes bla_VIM-4-like, bla_IMP-19-like, and bla_IMP-26-like (1 isolate each). Gene cassettes were missing in 75 % (36/48) of the integron-positive isolates.

Conclusions

The prevalence of carbapenem-resistant P. aeruginosa and Acinetobacter among hospitalized patients at Mulago Hospital is low compared to rates from South-East Asia. However, it is high among isolates and in the environment, which is of concern given that the hospital environment is a potential source of infection for hospitalized patients and health care workers.

Electronic supplementary material

The online version of this article (doi:10.1186/s40064-016-2986-7) contains supplementary material, which is available to authorized users.